dr. Julian ong,(singapore) k.-h. Lim†, j.-f. Lim* and ok.-w. Eu* departments of *colorectal surgical operation and †pathology, singapore general hospital, outram avenue, singapore
abstract:
aim solitary caecal ulcer syndrome is uncommon. We describe our revel in of 10 sufferers with the circumstance. Technique a prospectively gathered database of sufferers undergoing colonoscopy or surgical operation with histology reporting a solitary caecal ulcer became reviewed from 1999 to 2008. Patients with recognized carcinoma of the colon, cytomegalovirus infection, amoebiasis, inflammatory bowel sickness, immunosuppression and records of nonsteroidal anti inflammatory drug use had been excluded. Effects:
ten sufferers were found to have a solitary caecal ulcer. All had been of chinese language ethnicity, of median age sixty one years. The maximum commonplace providing signs were haematochezia and proper-sided stomach ache. Histological findings covered ulceration sharing a few functions of solitary rectal ulcer syndrome, but with differences to indicate a one of a kind aetiology. End:
solitary caecal ulcer syndrome must be covered inside the differential diagnosis of lower gastrointestinal haemorrhage, proper iliac fossa ache or while computed tomography imaging demonstrates caecal wall thickening. The diagnosis can simplest be made on histopathological exam. Keywords solitary caecal ulcer syndrome, benign, idiopathic
advent:
solitary, caecal ulcer syndrome is rare. The aetiology is unknown, and there aren’t any pathognomonic signs. The medical presentation is varied, but bleeding and ache are not unusual. Imaging with contrast research or computed tomography (ct) can also advise carcinoma of the caecum. The definitive prognosis is made simplest on histological examination. We describe our revel in of 10 sufferers with histology confirming a benign caecal ulcer, inside the absence of the aforementioned situations. Approach:
our potential database of patients undergoing colonoscopy or surgical operation with histology reporting a solitary caecal ulcer from 1999 to 2008 became reviewed. Patients with recognised
carcinoma of the colon, cytomegalovirus infection, amoebiasis, immunosuppression, nsaid remedy and inflammatory bowel disease were excluded. Effects:
ten sufferers had been found with solitary caecal ulcer among 1999 and 2008. The benign nature of the lesion was confirmed on biopsy at colonoscopy or on histological exam of the resected specimen after surgical procedure. All patients had been of chinese language ethnicity (5 guys), of median age 61 years (variety 52–89 years). The clinical, drug and surgical histories are summarized in desk 1. Of note, no patient gave any history of nsaid or potassium channel blocker medicinal drug. The maximum common symptom at presentation turned into haematochezia, accompanied by using proper-sided abdominal pain (table 1). Colonoscopy turned into the maximum commonplace diagnostic method completed (fig. 1, table 2). Five patients underwent surgical procedure for this situation, 3 due to a excessive suspicion of malignancy, one for increasing belly ache and one for severe rectal bleeding. Four patients recovered well, however the patient providing with extreme rectal bleeding succumbed on the second postoperative day after total belly colectomy to an acute myocardial infarction secondary to anaemia. The opposite five patients who had an ulcer with a benign appearance on colonoscopy have been handled with oral antibiotics. Recovery changed into finally showed on a repeat colonoscopic exam. Histopathological findings :
the histology in all 10 sufferers confirmed ulceration with granulation tissue and fibrinous exudate extending into the submucosa (fig. 2), in one patient, ulceration had reached the muscularis propria. Submucosal abscesses had been stated in 1/2 (five) of the patients. Disruption of the muscularis mucosae became noted in 9 of 10 patients, with thickening in half of (five) of the patients (fig. 3). In patients, there has been easy muscle proliferation. One patient had hyperplastic mucosal glands, even as the relaxation showed evidence of mucosal regeneration. No capabilities of ischaemia have been visible in any affected person. Dialogue benign colonic ulcers are observed maximum commonly inside the caecum and ascending colon and rarely involve the hepatic flexure [1]. It is visible with increasing frequency as using colonoscopy will become more commonplace [2]. An accelerated prevalence has been mentioned in sufferers on haemodialysis or after renal transplantation [3]. The collection indicates that solitary caecal ulcer takes place in patients over 50 years (median 61 years) and has an equal gender distribution. Preceding reports have defined the circumstance to occur normally within the fourth to 6th many years of life with a slight girl predominance [4,5]. The solitary rectal ulcer syndrome (srus) is characterized histologically through hyperplastic glands observed by using smooth muscle proliferation. Disruption of the muscularis mucosae is not characteristic of srus and thickening isn’t constantly seen. The clean muscle bundles which can be present in srus are typically aligned perpendicular to the mucosal floor and not parallel to the muscularis mucosae. Even though solitary caecal ulcer shows superficial similarities to srus, such as ulceration with granulation tissue and fibrinous exudates, extension of the ulcer into the submucosa is uncommon for srus. Disruption and thickening of the muscularis mucosae, regularly visible in caecal ulcer, isn’t typical of srus. The hyperplastic glands and easy muscle proliferation seen in srus are most effective very hardly ever visible in caecal ulcer syndrome. Feasible causes of solitary caecal ulcer, consisting of infection, pills and neoplasia, were discussed by way of chi et al. [6]. They had been attributed to infections such as cytomegalovirus [7,8], campylobacter jejuni [9] and
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